Turchan William Tyler, Gutiontov Stanley I, Spiotto Michael T, Liauw Stanley L
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA.
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
JNCI Cancer Spectr. 2020 Sep 11;4(6):pkaa081. doi: 10.1093/jncics/pkaa081. eCollection 2020 Dec.
Given similarities in the mediators of medication allergy (MA) and tissue response to radiotherapy, we assessed whether outcomes following prostate radiotherapy differ in patients with MAs.
A total 587 men with known MA history and nonmetastatic prostate cancer underwent radiotherapy from 1989 to 2006. Clinicopathologic and treatment variables were analyzed for association with freedom from biochemical failure (FFBF) and late treatment-related, physician-defined Radiation Therapy Oncology Group gastrointestinal (GI) and genitourinary (GU) toxicity. Covariates identified on univariate analysis for toxicity and disease control were examined on multivariable analysis. All statistical tests were 2-sided, and a less than .05 was considered statistically significant.
A total of 155 of 587 men (26.4%) had 1 or more MAs, most commonly to penicillin (n = 71), sulfa (n = 35), and aspirin or nonsteroidal antiinflammatory drugs (n = 28). On univariate analysis, men with MAs had superior 10-y FFBF (71.5% vs 63.5%, .02) and higher incidence of late GI grade 2 or higher (G2+; 20.6% vs 13.2%, .04) and grade 3 or higher (G3+; 7.5% vs 3.9%, .08) as well as late GU G2+ (42.5% vs 33.2%, .04) and G3+ (7.5% vs 3.0%, .02) toxicity than men without MAs. On multivariable analysis, MA history remained a statistically significant predictor of FFBF (hazard ratio [HR] = 0.64, 95% confidence interval [CI] = 0.43 to 0.93, .02), late G2+ GI (HR = 1.76, 95% CI = 1.06 to 2.90, .03), and G3+ GU (HR = 2.69, 95% CI = 1.16 to 6.27, .02) toxicity after controlling for corresponding covariates in each model.
Men with MAs had improved FFBF and increased treatment-related toxicity following radiotherapy for prostate cancer. MA history could be a relevant consideration in the management of men with localized prostate cancer.
鉴于药物过敏（MA）的介质与组织对放疗的反应存在相似性，我们评估了MA患者接受前列腺放疗后的结局是否有所不同。
1989年至2006年，共有587名有MA病史且患有非转移性前列腺癌的男性接受了放疗。分析临床病理和治疗变量与生化无复发生存（FFBF）以及放疗晚期、医生定义的放射治疗肿瘤学组胃肠道（GI）和泌尿生殖系统（GU）毒性的相关性。对单变量分析中确定的毒性和疾病控制的协变量进行多变量分析。所有统计检验均为双侧检验，P<0.05被认为具有统计学意义。
587名男性中有155名（26.4%）有1种或更多种MA，最常见的是对青霉素（n = 71）、磺胺类药物（n = 35）以及阿司匹林或非甾体类抗炎药（n = 28）过敏。单变量分析显示，有MA的男性10年FFBF更佳（71.5%对63.5%，P = 0.02），晚期GI 2级或更高级别（G2+）的发生率更高（20.6%对13.2%，P = 0.04），3级或更高级别（G3+）的发生率也更高（7.5%对3.9%，P = 0.08），以及晚期GU G2+（42.5%对33.2%，P = 0.04）和G3+（7.5%对3.0%，P = 0.02）毒性均高于无MA的男性。多变量分析显示，在每个模型中控制相应协变量后，MA病史仍然是FFBF（风险比[HR]=0.64，95%置信区间[CI]=0.43至0.93，P = 0.02）、晚期G2+ GI（HR = 1.76，95%CI = 1.06至2.90，P = 0.03）和G3+ GU（HR = 2.69，95%CI = 1.16至6.27，P = 0.02）毒性的统计学显著预测因素。
有MA的男性在前列腺癌放疗后FFBF改善，但治疗相关毒性增加。MA病史可能是局限性前列腺癌男性管理中的一个相关考虑因素。
